Provider Demographics
NPI:1730799875
Name:HOLMQUIST, KYLE ANDERS (NP-C)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDERS
Last Name:HOLMQUIST
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:AARON
Other - Last Name:BRENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-3110
Mailing Address - Country:US
Mailing Address - Phone:207-929-0170
Mailing Address - Fax:
Practice Address - Street 1:12 DEPOT ST
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7038
Practice Address - Country:US
Practice Address - Phone:207-569-2021
Practice Address - Fax:207-203-4641
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN73053163W00000X
NH086005-23363LF0000X
MECNP201064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse